Provider Demographics
NPI:1720767049
Name:GIVENS, JAY M (DPH)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:M
Last Name:GIVENS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 E BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4051
Mailing Address - Country:US
Mailing Address - Phone:417-887-5516
Mailing Address - Fax:417-887-4308
Practice Address - Street 1:3260 E BATTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4051
Practice Address - Country:US
Practice Address - Phone:417-887-5516
Practice Address - Fax:417-887-4308
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2000148994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist